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Journal of Neuro-Oncology
Published in: Journal of Neuro-Oncology 3/2015

01-12-2015 | Topic Review & Clinical Guidelines

The role of surgery in the management of patients with diffuse low grade glioma

A systematic review and evidence-based clinical practice guideline

Authors: Manish K. Aghi, Brian V. Nahed, Andrew E. Sloan, Timothy C. Ryken, Steven N. Kalkanis, Jeffrey J. Olson

Published in: Journal of Neuro-Oncology | Issue 3/2015

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Abstract

Question

Should patients with imaging suggestive of low grade glioma (LGG) undergo observation versus treatment involving a surgical procedure?

Target population

These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).

Recommendations

Surgical resection is recommended over observation to improve overall survival for patients with diffuse low-grade glioma (Level III) although observation has no negative impact on cognitive performance and quality of life (Level II).

Question

What is the impact of extent of resection on progression free survival (PFS) or overall survival (OS) in LGG patients?

Target population

These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).

Recommendations

Impact of extent of resection on PFS

Level II

It is recommended that GTR or STR be accomplished instead of biopsy alone when safe and feasible so as to decrease the frequency of tumor progression recognizing that the rate of progression after GTR is fairly high.

Impact of extent of resection on OS

Level III

Greater extent of resection can improve OS in LGG patients.

Question

What tools are available to increase extent of resection in LGG patients?

Target population

These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).

Recommendations

Intraoperative MRI during surgery

Level III

The use of intraoperative MRI should be considered as a method of increasing the extent of resection of LGGs.

Question

What is the impact of surgical resection on seizure control and accuracy of pathology in low grade glioma patients?

Target population

These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).

Recommendations

Surgical resection and seizure control

Level III

After taking into account the patient’s clinical status and tumor location, gross total resection is recommended for patients with diffuse LGG as a way to achieve more favorable seizure control.

Accuracy of diagnosis

Level III

Taking into account the patient’s clinical status and tumor location, surgical resection should be carried out to maximize the chance of accurate diagnosis.

Question

What tools can improve the safety of surgery for LGGs in eloquent locations?

Target population

These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma).

Recommendations

Preoperative imaging

Level III

It is recommended that preoperative functional MRI and diffusion tensor imaging be utilized in the appropriate clinical setting to improve functional outcome after surgery for LGG.

Intraoperative Mapping of Tumors in Eloquent Areas

Level III

Intraoperative mapping is recommended for patients with diffuse LGGs in eloquent locations compared to patients with non-eloquently located diffuse LGGs as a way of preserving function.
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Metadata
Title
The role of surgery in the management of patients with diffuse low grade glioma
A systematic review and evidence-based clinical practice guideline
Authors
Manish K. Aghi
Brian V. Nahed
Andrew E. Sloan
Timothy C. Ryken
Steven N. Kalkanis
Jeffrey J. Olson
Publication date
01-12-2015
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 3/2015
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-015-1867-1

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